Form ST-105 Indiana Department of Revenue State Form ...
Form ST-105
StateForm :19065 R'+/8-0-5
Indiana Department of Revenue
General SalesThx Exemption Certificate
locatedoutsideIndianamay usethis certificate.The claimedexemptionmust be allowedby Indiana
Indianaregisteredrelail merchantsand businesses
code. Exemption slatutesof other statesare not valid tbr purchasesfrom Indiana vendors.This exemption certilicate can not be issued for the
purchase of lLili/iqg, Vehicles, Watercraft, or Ai/crafr. Pttrcha.sermust be registered with the Depafiment of Revenue or the appropriate taxing
authorityofthe purchaser'sstateof residence.
Sales tax must be charged unless a!! information in each 6ection is fully completed by the purchaser. Purchasersnot able to provide all required
informationmust pay the tax and may file a ctaim for refund (Form GA- I lol-) directly with the Departmentof Revenue.
Name of Purchaser
City
Business Address
Zip
State _
P u r c h a s e rm u s t p r o v i d e m i n i m u m o f o n e I D n u n i b e r b e l c l w . t '
Provide your Indiana Registered Retail Merchant's Certificatc
TID and LOC Number as shown on your Certificate.
If not registered with the Indiana DOR, provide your State Tax
ID Number from anotherState......
*See instructions on the reverse side if vou do not have either number.
H
Is this a I
b l a n k e t p u r c h a s ee x e m p t i o n r e q u e s to r a I
TID# ( l0 digits)
LOC# ( 3 digits)
SrarelD#
Stateof Issue
s i n g l e p u r c h a s ee x e m p t i o n r e q u e s t ? ( c h e c k o n e )
D e s c r i p t i o no f i l e m s t o b e p u r c h a s e d .
Purchasermust indicatethe lype oI exemptionbeing claimedfor this purchase.(checkone or explain)
E Salesto a retailer,wholesaler,or manufacturerfor resale only.
E Saleof manufactu ng machinery tools. and equipmentto be useddirectly in direct production.
E Salesto nonprofft organizations claiming exemptionpursuantto SalesTax lnformation Bullelin #10.
(May not be usedfor personalhotel rooms and meals.)
E
Salesofrangible personalpropertypredominatelyused(greaterthen50 percent)in providing public transportation - provide USDOT#.
A personor corporalionwho is bauling undersomeoneelse'smotor carrierauthority,or has a contractas a school bus operator, must
providc their SS#or FID# in lieu of a StateID# in Section#1. USDOT# -
E Salesto persons,occupationallyengagedas famers, to be useddirectly in productionof agricultural productsfor sale.
Note: A farmer not possessinga StateBusinessLicense#may entera FID# or a SS# in lieu of a StateID# in Section#1.
E Salesto a contractor for exemptprojects(suchas public $chools,Sovemment,or nonprofits).
E Salesto Indiana Governmental Units (agencies,cilies, towns. municipalities,public schools,and slateuniversities).
El Sales to the United States Federal Government - show agency name.
Note: A U.S. Government asencv should enter its Federal Identification Number (FID#) in Section #1 in lieu of a State ID#.
E
Other - explain.
I herebycerlify under the penaltiesof perjury that lhe propeny purchasedby the use of this exemptioncertificateis to be used for an exempt
purposepursuanlto the StateCrossRetail SalesTax Act, IndianaCode6-2.5,and the item purchasedis not a utility, vehicle,watercraft,or aircraft.
I confirm my undeBtandingthat misuse,(?ifrer egligentor intentioral), and/orfraudulentuseofthis certificatemay subjectboth me personally
and/orthe businessentity I represenlto the impositionoftax, interest,and civil and/orcriminal penalties.
Signature of Purchaser
Date
Printed Name
Title
The Indiana Dcpartntent of Revenue may request verification of registration in another state if you are an out-of-state purchaser.
Seller must keep this certificate on file to support exempt sales.
For.mST-105
General Infonnation and Instructions
All four (4) sectionsof the ST-I 05 mustbe completedor the exemptionis not valid andthe seller is responsible
for thecollection of the Indianasalestax.
A) This sectionrequires an identification number. In mostcasesthis numberwill be an Indiana
DeparunentofRevenueissuedTaxpayerldentificationNumber(TID# - seenotebelow) usedfor
Indianasalesand/orwithholdingtax reporting. If the purchaseris from anotherstateanddoei not
license,or StateissuedID# mustbe provided.
possess
anIndianaTID#, a residentstate'sbusiness
possessing
purchaser
either
an
IndianaTID# or anotherStateID#, the following
not
B) Exceptions For a
may be usedin lieu of this requirement.
tr'ederalGovernment- placeyour FID# in the StateID# space.
Farmer - placeyour SS#or FID# in theStateID# space.
Public transportation haulers operatingunderanothermotor carrierauthority,or witb a contractasa
schoolbusoperator,mustindicatetheir SS#or FID# in the StateID# space.
Nonprolit Organization - mustshowits FID# in the StateID# space.
A) Check a box to indicateif this is a singlepurchaseor blanketexemption.
B) Describeproductbeing purchased.
A) Purchasermust checkthe reasonfor exemption.
B) Purchasermust be able to provide additionalinformation if requested.
A) Purchasermust sign and date the form.
B) Printed nameand title of signermust be shown.
Note: The Indiana Tlrxpayer Identification Number (TID#) is a ten (10) digit number followed by a thtee (3)
digit LOC#. The TID# is alsoknown as the following:
a) Registered Retail Merchant Certificat€
b) Tax Exempt Identification Number
c) SalesTax Identification Number
d) Withholding Tax Identification Number
The RegisteredRetail MerchantCertificateissuedby the Indiana DepartrnentofRevenueshows
the TID# ( I 0 digits) and the LOC# (3 digits) at the top right of the certificate'
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